An Evaluation of Musculoskeletal Interventional Ultrasound Training in Canadian Physical Medicine and Rehabilitation Residency Programs.

BACKGROUND: Ultrasound is a rapidly evolving field of medicine with strong utility in musculoskeletal practices. In Canadian physical medicine and rehabilitation (PM&R) residency programs there are no national standards for objectives of training in this area. This possible disconnection between demand and availability could lead to gaps in education. OBJECTIVE: (1) To determine the current state of interventional musculoskeletal ultrasound (MSUS) training in Canadian PM&R residency programs, as perceived by both residents and program directors; (2) to evaluate the perspectives of experts in the field on current and future MSUS curriculum inclusion. DESIGN: This study was a cross-sectional cohort study using an explanatory sequential mixed methods design. SETTING: This project included anonymous online surveys and targeted telephone/in-person semistructured interviews. PARTICIPANTS: Participants were Canadian PM&R residents or clinicians. Survey responses included 71 residents and nine program directors. Interviews were conducted with nine MSUS experts. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcome measures included residents' level of interest, amount of exposure, and barriers to training. Themes regarding resident exposure and future directions for MSUS training were obtained based on expert interviews. RESULTS: The vast majority (97%) of current PM&R residents are interested in using ultrasound clinically, with 73% reporting having had "none" to "limited exposure" in MSUS. Expert interviews revealed four major themes: (1) appropriate training is dependent on access, (2) MSUS represents an emerging standard of care, (3) a minimal baseline level of competence should be expected, and (4) various strategies may be used to integrate basic MSUS into existing residency curriculums. CONCLUSIONS: The use of ultrasound as a clinical tool is rapidly increasing. Current PM&R residents have a desire to incorporate this skill into their future practices. Although barriers exist to implementing this training on a national level, the future looks promising with multiple strategies outlined to assist the process.

Preworkout Supplement Induced Hemorrhagic Stroke: A Case Report.

ABSTRACT: Hemorrhagic stroke is a catastrophic cause of both long-term morbidity and mortality. Many risk factors for development of these strokes are in fact preventable or modifiable in nature. This case report outlines an incident involving a previously healthy 24-year-old man with no apparent risk factors apart from consumption of preworkout supplementation who developed a hemorrhagic stroke. The supplements that this particular patient was consuming included various potential causative agents-with the most significant being Dendrobium extract, which contains compound B-phenylethylamine, a precursor in the amphetamine formation pathway. This case study highlights the potential correlation between the consumption of preworkout supplementation and occurrence of hemorrhagic stroke, as well as the implications of understanding potential effects of the constituent ingredients in commercially available preworkout supplements.